TARGET PRACTICE: SIMULATION-BASED MASTERY LEARNING FOR ULTRASOUND-GUIDED PERIPHERAL IV INSERTION

Abstract

SESSION TITLE: Education, Research, and Quality Improvement 1 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 pm - 02:00 pm PURPOSE: Ultrasound use for peripheral IV (PIV) insertion has been shown to improve success rates and decrease overall time to placement [1,2]. Residents are often relied on to obtain venous access in patients with difficult access or an urgent need for intravenous medications; however, few studies have assessed competency-based training methods for internal medicine residents in ultrasound-guided (USG) PIV placement. We evaluated the effectiveness of simulation-based mastery learning of USG-PIV through a “train-the-trainer” approach. METHODS: Data on residents who participated in a simulation-based training on USG-PIV insertion was evaluated retrospectively. Internal medicine residents underwent a 1-hour simulation-based training with the expectation of performing USG-PIV placement to mastery standards on a task trainer. Pre and post-surveys were completed on the day of training. Survey questions regarding self-confidence and skills were rated on a numerical scale of 1-5, with 5 representing high confidence. Skill performance was assessed by an approved trainer using a detailed checklist upon completion of training. RESULTS: Eleven residents completed the training during a 2-week period. 73% (N= 8) were PGY-2 and 27% (N = 3) were PGY-3. Seventy-three percent (N=8) had received general ultrasound training previously, but none had received formal ultrasound training for PIV insertion. Forty-five percent (N=5) of residents had never placed an USG-PIV, and 55% (N=6) had placed less than 5 USG-PIVs. Self-confidence and self-skills assessment improved significantly after training. Average self-confidence in correctly identifying the vein using USG by transverse and longitudinal technique was significantly higher post-simulation (3.0 vs 4.6, p=0.008 and 2.3 vs 4.5, p=0.002, respectively). There was also a significant increase in self-confidence following the needle tip into the target vein using USG transverse and longitudinal technique (2.3 vs 4.5, p=0.001 and 1.9 vs 4.3, p=0.001, respectively). Residents met the mastery standard for skills with a 100% pass rate on the skills-based checklist. CONCLUSIONS: A simulation-based mastery learning model for USG-PIV insertion improves resident self-confidence, self-skill assessment and technical skills in a simulated environment. Deliberate practice with a mastery learning model ensures that each learner has achieved the necessary skill set to place a PIV using USG. CLINICAL IMPLICATIONS: We developed a feasible and time-efficient method for USG-PIV training that relies on developing a group of resident “super-users.” We look to evaluate the effect of this train-the-trainer approach for USGPIV insertion on internal medicine resident skill, behaviors and patient outcomes. DISCLOSURES: No relevant relationships by Karishma Bhatia, source=Web Response No relevant relationships by Hailey Gupta, source=Web Response No relevant relationships by Krystle Hernandez, source=Web Response No relevant relationships by Paru Patrawalla, source=Web Response No relevant relationships by Adam Rothman, source=Web Response No relevant relationships by Daniel Steinberg, source=Web Response